The official logo of the immoral institution calling itself the "National" Health Service

The official logo of the immoral institution calling itself the "National" Health Service

I’m going to try something. I’m going to state my position and a few brief reasons why I hold it. I’m then going to open up the comments section for you guys to tell me a) why I’m wrong b) why you agree mostly but you have x concern that means we need an NHS or c) any personal experiences you’ve had with the NHS that might influence my opinion that you’d like to add. This can be as an employee or a patient. I will then attempt to flesh out this article with answers to some of these common concerns, arguments etc.

WHY THE NHS ABSOLUTELY MUST BE ABOLISHED ENTIRELY

1) The NHS is entirely funded through stolen tax payer money and is therefore inherently unjust

2) Even if you believe taxation is not unjust, the NHS must still be abolished entirely because it is completely unaccountable, unresponsive and terrible at the job of providing medical care

3) The NHS has perverse incentives which is ruining the important job of providing healthcare. People are dying because healthcare is being misallocated, overconsumed, underprovided in certain areas etc. etc.

4) The NHS does not produce innovation, the cost of everything is going up and the waiting lines are increasing.

5) Poor people are forced to use the NHS because they cannot opt out of paying taxes, therefore they find it almost impossible to go private because they are literally being asked to pay twice.

6) Because the NHS does not have the profit/loss incentives of the free market, its employees have no incentive to be friendly, efficient or do their job well. If they fuck up, they don’t lose money (because their wages are simply stolen from people). In fact often they gain money because they can argue their failures are because their budget isn’t high enough. This isn’t an argument that there are no good people working in the NHS but simply that on the average, they are always going to be ruder, more unreasonable and slower than people working in the private sector.

In Summary the NHS is causing poor people to die, stifling medical innovation and plundering our wealth through forced taxation. The institution is unaccountable, wasteful and growing all the time without producing better results.

It must be abolished.

Tell me why I’m wrong.

09/12/2009 Chris makes the following objections

1) ’stolen’ implies the taxation is unlawful, when of course it isn’t. If you disagree with the law(s) passed to enforce taxation, please say why.

In my opening post I laid out the libertarian philosophy. Unlike traditional politics libertarian politics holds certain things immoral l REGARDLESS of whether some bureaucrats have written it down in a book or not. Most people agree that just because something is a law doesn’t make it automatically okay. For example, slavery was once enforced by law. Libertarians object to taxation because it it the forceful stealing of money, something we do not accept in any other part of our lives.

2) how would you make the NHS more accountable? There may be a website where you can post your views/suggestions.

how would you make the NHS more responsive? I assume this is in relation to things like how quickly ambulances arrive, which are not entirely within the control of the NHS

you say that the NHS is ‘terrible at the job of providing medical care’, I assume in comparison to paying to go private. you acknowledge that this is not an option for everyone, so how could the NHS provide better medical care?

I wouldn’t make the NHS “more accountable” because I couldn’t. It is impossible. Government agencies are inherently unaccountable because 1) People cannot withdraw their funding voluntarily and 2) the employees from the ground up to the very top dogs don’t have the right incentives to please their customers. In the private sector if you fuck up you lose your customers and you lose money. In the NHS if you fuck up you get a bigger budget the next year.

Same goes for speed of ambulances etc. There are many people  inside the system who want to do a good efficient job but unfortunately, on the average, the incentives are horribly distorted because it is a government agency and therefore everything will be done less efficiently than on a free voluntary market.

I do indeed mean in comparison to private companies. I acknowledge that in our current system not everybody can go private. I want the abolition of the NHS and for every single £pound to be left in the hands of the people to prepare for their own medical care. For those few people who are so poor they cannot afford insurance, I want individuals and local charity to pick up the slack. If anybody doubts that people care about the poor getting sick and worries they would not pay to such charities all I can say is that every single person I’ve ever spoken to about libertarian ideas has brought this issue up first, everybody is concerned about it, so everybody should be willing to help as individuals unless they are hypocrites.

3) I’d agree that NHS provision isn’t the same everywhere, so it will be better in some places than others.

NHS provision will never be properly distributed because it’s funds aren’t properly appropriated. When you run your company through theft, you do not have the correct profit/loss incentives to correctly distribute scarce resources. Remember the shortages and bread lines in the Soviet Union.

4) I did not know that the NHS had to produce innovation, is this a legal requirement? Obviously, innovative use of funds is a good idea. I assume that costs are dependent on outside factors (including those caused by private companies) and I would guess that long waiting lists are caused by poor management of scarce resources.

It does not have a legal or moral obligation to do so. I was simply pointing out that it won’t. It can’t. When taking risks to produce innovations you need the profit/loss incentives of the free market. The UK has been piggy-backing off the medical innovations coming out of America and other countries with freer markets than ours for the last 50 years. And if America totally socialises its system we may be headed into a new medical dark age. I’m sure you can see how this hurts every individual, rich and poor.

And you are absolutely correct about what causes the long waiting lists. The only fallacy is in thinking that government bureaucracies can ever be reformed. The NHS will only continue to grow and become less and less responsive to patients until we finally get rid of it once and for all and transition to a voluntary system of providing healthcare.

5)This works as an argument for helping people with the cost of going private, for people with such rare conditions that only experimental treatments being developed by private companies or overseas have a chance of working. The NHS would argue that they do not have the resources, or it is not their role, to be developing such experimental treatments, or testing them all. Perhaps it should have this role (if it already does, it obviously needs better management/more resources).

I can’t think of anything worse than handing over the role of innovating new medical advances to the UK government. Anything we can do to reducing the size and scope of government is good for the people, anything in the other direction, be it laws, regulations or new departments  will only impoverish the people further.

6) Everyone has bad days and some people will never do their job to the best of their abilities. I agree that the financial imperative is a strong force in society, but the NHS isn’t the reason it exists, so it shouldn’t be blamed.

It is true that everybody has bad days and that some people will never do their job to the best of their abilities. However only in government organisations does this behaviour go unpunished. Because we do not have the option of withholding our tax money to fund this massive organisation they are shielded from the correct profit/loss incentives that the free voluntary market provides. If you go to a private vet and the receptionist is rude or the vet does a bad job of fixing Fidos leg you can stop frequenting the business, therefore those workers have a direct incentive to do a better job or the Vet on the other side of town will scoop up their business. If they piss off enough of their customers with bad service, they will go bankrupt. When the NHS pisses off tons of their customers, they get a bigger budget the next year.

Local GP’s around the country often find it an INCONVENIENCE when they have to take on a new patient. If somebody is unhappy with their service or the wait they have to endure to undergo treatment what choice do they have? The surgery does not care whether you are unsatisfied or if you decide to go private because to them, it doesn’t matter if they get your custom or not.  Again, individuals in the system may care, but on the aggregate, they will care much less than people operating in the free market.

Another way to put it is there are good people, and there are bad people. In the free market, bad people must still provide a good friendly service to some degree or they will be fired or their business will be uncompetitive to those run by good people. In the government sectors good people are not rewarded and bad people are not fired. In fact in politics often the most sneaky, deceptive and manipulative people rise to the top, and this includes organisations like the NHS with its famous “glass ceiling”.

The NHS could be better, should be better, but scrapping it helps noone. Unless you have a vested interest in private healthcare, of course.

Scrapping it would help no one if it was actually “free” but of course it’s not. To fund this behemoth people have to have a sizeable portion of their income extorted through force. Everybody, including the poor (who taxes actually hurt the most) would be better off being allowed to keep that money and redirect it to the healthcare provider OF THEIR CHOICE. In that situation we would see medical costs rapidly declining, innovation rising and quality of service and wait times DRAMATICALLY increasing.

Thanks for your comment :)

Elad writes on 11/12/2009

As an employer with the NHS for over 3 years i think i can tell you a few truths about why the system is crap! Lets be honest its not all the nhs fault, due to it being a government funded workforce the there loads of front headed targets therefore staff are unable to supply the best possible treatment, such as the ambualnce, if we get to a job within 8 minutes of a call that is a success even if the patient has died, but if we get there after 8 minutes and the patient lives, we fail to meet the target, and sometimes have a meeting as to why we did not get there in time.

Okay there seems to be a cognitive disconnect between “the NHS” and “the Government”. The NHS IS the government which is why it has all the problems you’ve just mentioned. The individuals working within the NHS might be good hard working people, in fact in the majority I think they are, and it is not them I have a problem with. It is the INSTITUTION of the NHS. And what makes it a unique institution? They are not funded by people valuing their service, either through paying for care or through charity donations. No, instead they are funded through coercion. That is, stolen money (tax). Because of this we get the perverse incentives, ridiculous paper work, misallocation of resources and grinding inefficiency.

Even people who disagree with me will always qualify their statements with stuff like “There are many problems with the NHS”… what I don’t understand is why the good people want to protect the system at all.  I can understand why the politicians and the higher ups want to protect it, but the lower downs, the doctors, the nurses, the surgeons would all find similar work in the private sector or in voluntary charity, were the NHS abolished, but now they’d actually get work done and wouldn’t have to deal with all the bullshit.

All clinical staff are accountable for mistakes and are dealt with within the protocol and a company called the Health Proffesions Council may get involved. Go to A&E on a friday and saturday night and see why the nhs is actually abused by the public, count it roughly £1500 per head, with ambulance, treat in A&E then sent home!! i agree that there are too many managers. Also the funding has never increased with inflantion!!! these problems are not the fault of staff but the fault of poor government that don’t provide appropriate targets.

Sorry to be blunt but no, all clinical staff are NOT accountable for mistakes. In fact it is almost impossible to be fired from the NHS and the people who do the investigations work for the same people as the NHS (the government) so their incentives are again distorted. Of course the NHS is abused by the public (although they also pay for it). When you give something away for free, don’t expect people to use it wisely. Without prices, resources get allocated incorrectly. The only way to find the correct prices (because prices are subjective) is on a marketplace. And the NHS does NOT need more funding. It consistently gets bigger and bigger and bigger and bigger and the care gets worse and worse. Money is not the problem. It’s where that money comes from.

you only hear the bad stories, i personally had a couple of jobs, one was a baby who was fitting, from the time they called to the time we got the baby to hospital was 14 minutes, the baby is now living, also had a patient that was having a heart attack, because of the drugs we gave and going to the best hospital for that condition, that patient has a better quality of life, it’s not always bad news!!!

If you would rather go private thats fine, lets end up like USA???? i dont think so

Of course there are cases where good things happen in the NHS. This is because it is staffed by hundreds of thousands of doctors and nurses, most of whom are good people who provide a valuable service. The problem isn’t doctors, nurses and surgeons, IT’S THE NHS AND HOW IT’S FUNDED. I am not in favour of abolishing doctors. These good people would still be employed on a free market, and they would still be saving babies. Please read my FAQ for more on why this fallacy is so ubiquitous.

As to your last point, if I’d like to go private it’s not “fine” because I have had money STOLEN from me to pay for the NHS. If I could opt out of the NHS and spend that money on private care I obviously would because it is vastly superior. As usual, the government program enacted under the guise of “helping the poor” actually hurts them the most because they can’t afford to pay twice, unlike the rich.

Also the USA does not have a free market health care system. It is slightly freer than ours in certain areas, but it is NOT free. Despite this it is still free enough to lead the way with most of the new medical advancements which we piggy back off of. If Obama manages to totally socialise their system, like he wants to, we might find the world entering a new medical dark age, where no country any longer has the necessary profit/loss incentives to invest capital in new medical innovation.

Thanks for your comment.